Hassan Mohamed1, Hisham Hosny2, Pierre Tawadros Md1, Mohamed Elayashy Md Desa Fcai1, Hossam El-Ashmawi Md1. 1. Department of Anesthesia and Intensive Care, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt. 2. Department of Anesthesia and Intensive Care, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.; Department of Anaesthesia, Royal Brompton Hospital, Royal Brompton and Harefield Foundation Trust, London, United Kingdom. Electronic address: hishamhosny@kasralainy.edu.eg.
Abstract
OBJECTIVES: Cardiac surgery is characterized by attenuation of microcirculatory perfusion. Dexmedetomidine has been proved to attenuate the microcirculatory derangements evoked by experimental sepsis. The authors investigated the effects of dexmedetomidine infusion on sublingual microcirculation in patients undergoing on-pump coronary artery bypass graft (CABG) surgery. DESIGN: Prospective, randomized blinded study. SETTINGS: Tertiary university hospital. PARTICIPANTS: A total of 70 adults undergoing elective on-pump CABG surgery. INTERVENTION: After a standard general anesthesia, participants were allocated randomly to receive either propofol continuous intravenous infusion, 50 to 70 µg/kg/min, or propofol infusion, 50 to 70 µg/kg/min plus dexmedetomidine infusion, 0.5 µg/kg/h, during cardiopulmonary bypass. Microcirculation was studied with side-stream dark field imaging at 3 times: immediately before starting bypass (T0), 30 minutes after initiation of bypass (T1), and 30 minutes after weaning from bypass (T2). MEASUREMENTS AND MAIN RESULTS:Microvascular flow index was significantly higher in the dexmedetomidine group at T2 compared to the control group (2.20 ± 0.29 and 1.47 ± 0.30, respectively; p = 0.001). The perfused vessel density was significantly higher in the dexmedetomidine group at T2 compared to the control group (6.1 [3-8.9] mm/mm² and 3.3 [2.2-4.3] mm/mm², respectively; p = 0.01). The total vascular density was significantly higher in the dexmedetomidine group compared to the control group at T1 and T2 (9.9 [7.8-12.6] mm/mm² v 7.4 [6.1-9] mm/mm², p = 0.005; and 9.27 ± 2.27 mm/mm² v 7.24 ± 1.66 mm/mm², p = 0.003, respectively). CONCLUSION: This trial demonstrated that dexmedetomidine infusion improved sublingual microcirculation indices in patients undergoing on-pump CABG surgery.
RCT Entities:
OBJECTIVES: Cardiac surgery is characterized by attenuation of microcirculatory perfusion. Dexmedetomidine has been proved to attenuate the microcirculatory derangements evoked by experimental sepsis. The authors investigated the effects of dexmedetomidine infusion on sublingual microcirculation in patients undergoing on-pump coronary artery bypass graft (CABG) surgery. DESIGN: Prospective, randomized blinded study. SETTINGS: Tertiary university hospital. PARTICIPANTS: A total of 70 adults undergoing elective on-pump CABG surgery. INTERVENTION: After a standard general anesthesia, participants were allocated randomly to receive either propofol continuous intravenous infusion, 50 to 70 µg/kg/min, or propofol infusion, 50 to 70 µg/kg/min plus dexmedetomidine infusion, 0.5 µg/kg/h, during cardiopulmonary bypass. Microcirculation was studied with side-stream dark field imaging at 3 times: immediately before starting bypass (T0), 30 minutes after initiation of bypass (T1), and 30 minutes after weaning from bypass (T2). MEASUREMENTS AND MAIN RESULTS: Microvascular flow index was significantly higher in the dexmedetomidine group at T2 compared to the control group (2.20 ± 0.29 and 1.47 ± 0.30, respectively; p = 0.001). The perfused vessel density was significantly higher in the dexmedetomidine group at T2 compared to the control group (6.1 [3-8.9] mm/mm² and 3.3 [2.2-4.3] mm/mm², respectively; p = 0.01). The total vascular density was significantly higher in the dexmedetomidine group compared to the control group at T1 and T2 (9.9 [7.8-12.6] mm/mm² v 7.4 [6.1-9] mm/mm², p = 0.005; and 9.27 ± 2.27 mm/mm² v 7.24 ± 1.66 mm/mm², p = 0.003, respectively). CONCLUSION: This trial demonstrated that dexmedetomidine infusion improved sublingual microcirculation indices in patients undergoing on-pump CABG surgery.
Authors: John C Greenwood; David H Jang; Stephen D Hallisey; Jacob T Gutsche; Jiri Horak; Michael A Acker; Christian A Bermudez; Victoria L Zhou; Shampa Chatterjee; Frances S Shofer; Todd J Kilbaugh; John G T Augoustides; Nuala J Meyer; Jan Bakker; Benjamin S Abella Journal: J Cardiothorac Vasc Anesth Date: 2020-05-14 Impact factor: 2.628
Authors: Fiona J Gifford; Francesca Moroni; Tariq E Farrah; Kirstie Hetherington; Tom J MacGillivray; Peter C Hayes; Neeraj Dhaun; Jonathan A Fallowfield Journal: J Clin Med Date: 2020-10-17 Impact factor: 4.241